Haemodialysis and the risk of stroke: A population-based cohort study in Taiwan, a country of high incidence of end-stage renal disease

  1. CHIEN-CHUN KUO1,
  2. CHIEN-TE LEE1,
  3. SHU-CHEN HO2,
  4. HSIN-WEI KUO3,
  5. TRONG-NENG WU4,
  6. CHUN-YUH YANG2,*

Article first published online: 23 FEB 2012

DOI: 10.1111/j.1440-1797.2011.01551.x

Issue

Nephrology

Nephrology

Volume 17, Issue 3, pages 243–248, March 2012

Additional Information

How to Cite

KUO, C.-C., LEE, C.-T., HO, S.-C., KUO, H.-W., WU, T.-N. and YANG, C.-Y. (2012), Haemodialysis and the risk of stroke: A population-based cohort study in Taiwan, a country of high incidence of end-stage renal disease. Nephrology, 17: 243–248. doi: 10.1111/j.1440-1797.2011.01551.x

Author Information

  1. 1

    Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang-Gung Memorial Hospital and Chang-Gung University College of Medicine

  2. 2

    Department of Public Health, College of Health Sciences, Kaohsiung Medical University

  3. 3

    Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung

  4. 4

    Graduate Institute of Public Health, China Medical University, Taichung, Taiwan

*Professor Chun-Yuh Yang, Department of Public Health, Kaohsiung Medical University, 100 Shih-Chuan 1st RD, Kaohsiung 80708, Taiwan. Email: chunyuh@kmu.edu.tw

  1. Conflict of Interest: None.

Publication History

  1. Issue published online: 23 FEB 2012
  2. Article first published online: 23 FEB 2012
  3. Accepted manuscript online: 15 DEC 2011 08:08AM EST
  4. Accepted for publication 30 November 2011.; Accepted manuscript online 15 December 2011.

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Keywords:

  • cohort study;
  • end-stage renal disease;
  • stroke

ABSTRACT:

Aims:  Data regarding the occurrence of stroke in dialysis patients are limited and epidemiologic studies to date are controversial with respect to the stroke subtype among dialysis patients. The aim of this study was to perform a population-based study with a retrospective cohort design to investigate the risk of stroke after the initiation of haemodialysis (HD) among end-stage renal disease (ESRD) patients in Taiwan – a country with the highest incidence of ESRD in the world.

Methods:  Data were retrospectively obtained from the Taiwan National Health Insurance Research Database. In total, 644 patients who were beginning HD between 1999 and 2003 were recruited as the study cohort and 3220 patients matched for age and sex were included as the comparison cohort. Multivariate Cox proportional hazard regression models were used to adjust for confounding and to compare the 5 year stroke-free survival rate between these two cohorts.

Results:  The incidence rate of stroke (41.76 per 1000 person-years) was significantly higher in the HD cohort than in the control cohort (24.29 per 1000 person-years). After adjusting for potential confounders, the adjusted hazard ratios of ischaemic stroke and haemorrhagic stroke were 2.16 (95% confidence interval = 1.57–2.97) and 3.78 (95% confidence interval = 1.90–7.55), respectively.

Conclusion:  We conclude that HD patients were at an increased risk for both ischaemic and haemorrhagic stroke compared with the general population.

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